The overarching aim of this thesis was to contribute towards the translation of a laboratory paradigm into a clinical intervention: that is, to develop a positive Cognitive Bias Modification (CBM) technique using mental imagery into an internet-based computerized intervention for people with clinical depression. Preliminary studies using an imagery-based CBM to modify interpretation bias in depression have shown significant effects of the CBM in alleviating depressive symptoms. We know very little, however, about the mechanisms underlying the beneficial effect of imagery-based CBM in depression. A particular focus of the current thesis was to explore the effects of imagery-based CBM on variables that were thought to contribute to symptom improvement: mental imagery, emotion and behaviour. Experiment 1 explored these effects in a sample of mildly depressed individuals, using a CBM paradigm in which participants were required to generate mental imagery in response to positive, negative or mixed (control) combinations of picture and word cues. Participants assigned to the positive imagery condition showed mood improvements as well as enhanced behavioural performance (fishing game task) and reduced cognitive bias compared to participants in the two other conditions. Further, positive imagery was rated as increasingly vivid as they went along with the training. Study 2 explored the possibility that the behavioural task (i.e. a fishing game) used in mildly depressed individuals to detect CBM-induced differences in behaviour could be associated with behavioural differences between individuals with various and clinical levels of depressive symptoms. The hypothesis was tested that in a sample of individuals with minimal to severe symptoms of depression, behavioural performance on the fishing game would be inversely related to the severity of their depressive symptoms. As predicted, participants with higher depression scores performed less well on the fishing game task than those with lower scores, and this association remained when controlling for other variables such as state mood. Experiment 3a and 3b constituted the first two pilot studies exploring the feasibility of delivering imagery-based CBM over the internet to individuals with clinical depression. In Experiment 3a, the imagery-based CBM was developed into an internet-based intervention involving 6 sessions of CBM that participants completed in their own home over a week. The Oxford Imagery Generation (OxIGen) program was piloted in a small sample (N = 6) of clinically depressed individuals, and qualitative data were collected to assess experience of the intervention. As a result, refinements were made to improve the intervention and enhance engagement. In Experiment 3b, the finalised version of the OxIGen program, which involved 12 sessions of online CBM completed over a month, was piloted in a small sample (N = 8) of individuals with clinical depression. Results showed high levels of acceptability and adherence. Three of the four participants allocated to the positive imagery version of OxIGen showed reliable levels of symptom improvement. The exploration of the effects of OxIGen on mental imagery, bias and behaviour provided a mixed picture. For example, the predicted change in vividness for positive future imagery and negative interpretative bias was only found in two of the four participants from the positive imagery group. Finally in Experiment 4, the effects of OxIGen on positive future imagery and behaviour were examined as part of a wider clinical trial involving a large sample (N = 150) of individuals with clinical depression. The larger scale of this study allowed a sufficiently powered test of the prediction that the intervention would lead to changes in specific features of imagery (i.e. vividness and likelihood of positive future imagery) and increases in behavioural activation. Further, the hypothesised link between positive future imagery and optimism was tested. The results examined whether the OxIGen intervention can induce changes at different levels of psychological functioning (i.e. emotional, cognitive and behavioural). It is discussed that the combined action of these changes may reinstate a positive feedback cycle that ultimately leads to symptom improvements. Existing resources are largely insufficient to combat the major health problem of depression. The development of a promising laboratory paradigm towards a clinical intervention is an important step towards the development of short and inexpensive forms of treatment that can be delivered to the hands of the many people who need help.

Master of Landscape Architecture / Department of Landscape Architecture/Regional and Community Planning / Jessica Canfield / Landscape architecture is embarking on a new design frontier, one where its practitioners are increasingly being asked by clients to design using credible evidence and to ensure design performance. As design disciplines follow in the footsteps of other evidence-based practices, like medicine and engineering, landscape architecture is poised to become a more scholarly profession – a profession of evidence-based landscape architecture. Evidence-based landscape architecture was first coined and defined in 2011 by Brown and Corry as “the deliberate and explicit use of scholarly evidence in making decisions about the use and shaping of land” (Brown and Corry 2011, 328). Current literature explains the benefits of practicing evidence-based design (EBD). These include ensuring design performance, justifying client investment, quantifying the value of design, systematically managing complex projects, marketing the firm to clients, attracting the most innovative designers to the firm, and adding to the knowledge base of the landscape architecture field. However, little is known about how landscape architecture firms are engaging evidence-based design in daily practice. This thesis examines how four leading landscape architecture firms (Design Workshop, Mithun, Sasaki Associates, and OLIN) have developed unique EBD approaches to integrate, apply, and propagate evidence-based design in professional practice. In order to study and analyze the four firms’ EBD approaches, individual comprehensive case studies were conducted. Qualitative data was collected through: focused interviews with directors and leaders of evidence-based design at each firm; casual observations made during office visits; and, a review of firm literature. A case study framework for EBD approaches in professional practice was developed based on discussion topics that consistently emerged from the interviews. The framework was used to organize, analyze, and present the findings into four major themes. A cross-case analysis was conducted to compare the development, implementation, and effects of EBD approaches at each firm. Findings reveal that each firm has developed an EBD approach to meet the need for engaging complex problems and meeting increasing client expectations for performance. While each firm’s EBD approach is unique, similarities and characteristics emerged between the case studies. The most consistent factors identified across cases include: having academic founders of the firm; the implementation of EBD- or research-specific roles and responsibilities; the creation of tools to organize and understand data; cultivating design cultures to support the EBD approach vision; the communication and transparency of relationships with clients and consultants; and, the reporting of findings for the advancement of the profession. Although any landscape architecture firm is likely to employ at least one of these concepts, the developed integration, application, and propagation of a majority of these concepts is what makes these firms unique and successful in applying EBD in professional practice. It was also found that the design processes themselves vary dramatically across the firms. EBD in practice is therefore not prescriptive and does not always look the same. The findings and case study framework developed in the study are useful primarily for landscape architecture firms looking to develop, integrate, apply, and propagate their own EBD approach.

The purpose of this exploratory study was to examine school psychologists' use of evidence- based practices (EBP), in general, and more specifically in the area of social skills training (SST) for students with autism spectrum disorders (ASD). Study participants, consisting of 498 school psychologists from across the nation, participated in an online survey that gathered information about their training, attitudes, and practices. The frequency with which specific EBP practices for social skills training for students with ASD was examined, as was prediction of use of these practices. Multiple-regression analyses revealed multiple independent variables that were predictors for overall use of EBP. Results indicated that over half of the participants provide SST for students with ASD. Although the majority of participants indicated that their graduate program included at least one course with information about ASD and EBP practices, in general, nearly half indicated that their coursework did not include any courses that directly addressed social skills training for students with ASD. Confirmatory factor analysis (CFA) was used to determine the extent to which the data fit the factor model. Participants' perception of the importance placed on EBP by their school district, scores on the openness subscale of the Evidence Based Practices Assessment Scale, perception of how well their graduate program prepared them in the EBP process, perception of whether they were adequately trained in the area of SST for students with ASD, and having a caseload evenly divided among settings were significant predictors of overall use of EBP.

Currently there is extensive literature on evidence-based practices (EBP) for students with autism spectrum disorder (ASD). However, there is limited research on whether or not these practices are implemented in the classroom by teachers serving students with ASD. Special education teachers are responsible for the learning outcomes of students across a range of ages and disabilities. This study investigated teachers' self-reported use of EBP and what factors influence implementation. Participants included 129 special education teachers in Texas public schools. Data utilizing descriptive statistics and logistic regression was conducted to determine what factors (i.e., education, employment, teaching experience and training methods) predicted implementation of a particular practice. Although 67% of teachers reported using EBPs, teachers' employment and training experiences did not predict the implementation of a particular practice. Information from this study can be used to enhance professional development for teachers serving students with ASD.

What are the design possibilities for the adaptive reuse of an outdated mall into a community centered case study model of pediatric palliative care?This thesis therefore explores the following questions. What solutions are possible in the adaptive reuse of Cloverleaf Mall? As designers what is our responsibility when reusing existing spaces? How and in what ways can design build community? How can design create a place which meets the personal needs of patients with a wide variety of illnesses in various stages of progression? What does the design of a centralized prototype for pediatric palliative care look like?

High quality assessment services are the linchpin connecting youth with mental health problems to diagnosis-specific, evidence-based treatments. The effort to improve assessment services is in its early days and faces a number of substantial challenges. This study was an initial effort to address these challenges through the development of a standardized, multi-dimensional Assessment Instrument evaluation tool—the Strength of Measure (SoM)—based on operationally defined criteria supported by decades of psychometric research. The SoM and other criteria addressing assessment practices were piloted with data from 32 consecutive assessment reports from a community mental health center’s Assessment Clinic. Results indicate that none of the Assessment Instruments used by the Assessment Clinic met the “Adequate” level of support on each of the SoM dimension. Additional results address Reason for Referral, Primary Axis I Diagnosis, Informants, and Method of Assessment. Implications and directions for future research are discussed.

ABSTRACT PREPARING TEACHERS OF STUDENTS WITH AUTISM SPECTRUM DISORDER: EVIDENCE-BASED PRACTICES AND TEACHER SELF-EFFICACY By Jane E. Strong A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University. Virginia Commonwealth University, 2014 Major Director: Evelyn Reed, Ph.D., Associate Professor Department of Special Education and Disability Policy School of Education There is a need for intensified, rapid, and special emphasis on training of teachers for students on the autism spectrum (NRC, 2001). The current movement in the field emphasizing the use of evidence-based practices in designing instructional methods should be emphasized during teacher preparation and professional development activities to increase teacher effectiveness. Further, it has been established that a teacher’s sense of self-efficacy (Bandura, 1979; Hoy & Tschannen-Moran, 1998) impacts his/her performance and that of his/her students. The purpose of this study was to discern and describe teachers’ perceptions of their self-efficacy following professional development that includes training in the use of evidence-based practices. This was accomplished through analysis of survey data, field based observations and interviews from teachers completing their Post-baccalaureate Graduate Certificate in Autism Spectrum Disorders at a large, urban university in a mid-Atlantic state. To add to the literature base about the influence of ASD-focused professional development, this study examined teacher perceptions of the professional training and the relationships between teachers’ knowledge and skill acquisition and self-efficacy.

The goal of the current study was to develop and test a rigorous measure of therapist adherence to a cognitive-behavioral, manual-based treatment for childhood and adolescent depression. This project employed data from the recently completed UCLAYouth Anxiety and Depression Treatment study. This study aimed to advance the literature by devoting the full focus of the project to the development of a manual-based measure that would demonstrate interrater reliability across multiple raters. This study reported on the psychometric development of the PASCET Manual Adherence Scale (PMAS) (e.g. scoring strategy, item development, reliability), a unique measure of therapist adherence that represents the content of the treatment manual for the "Primary and Secondary Control Enhancement Training" program (PASCET; Weisz et al., 1999). In sum, the P-MAS showed strong interrater reliability for most items of the scale. The items with poorer ICCs may have been influenced by instrumentation problems, small sample size, and range restriction. Some session content showed evidence that more meetings may be required to sufficiently cover the material, particularly for those that involve heavy in-vivo content, require the use of technology, or involve cognitive interventions which may be challenging for children and young teenagers. The results indicated that therapists adhered to slightly more than half of the prescribed manual content overall. The variability in adherence appeared greater for session-specific content than for standard session items, reflecting the variability within that content and the myriad of factors which may have influenced adherence to diverse material. Adherence for session-specific content demonstrated a slightly downward trend over time, with a significant drop off between the first and second phases of treatment and a leveling off between second and third phases. For all but two relevant sessions, therapist adherence to didactic content was significantly higher than adherence to in-vivo content, highlighting the challenges of engaging depressed youth in active learning. As this active involvement is theorized to be an essential component in addressing depressive symptoms, the challenges in implementation of this content may represent the most significant barrier to therapist adherence with this manual.

Background: Orphanhood is a major consequence of the HIV/AIDS epidemic in sub-Saharan Africa. There is little evidence concerning psychological problems for AIDS-orphaned children. This thesis explores the relationship between orphanhood status and mental health. It also examines mediating influences of environmental risk and protective factors, and interactions between factors, on children’s psychological problems. Methods: 1200 isiXhosa-speaking children were interviewed, using standardised questionnaires, in deprived urban settlements of Cape Town. A qualitative stage with 60 AIDS-orphaned children, 42 caregivers and 20 professionals explored participant perceptions of risk and protective factors. A quantitative stage compared 1025 AIDS-orphaned children to control groups of other-orphans and non-orphans. Data were analysed with t-tests, chi-sq, anovas, regression and log-linear analyses. The study took place in collaboration with Cape Town Child Welfare. Results: AIDS-orphaned children reported more depression (p<.001), peer relationship problems (p<.001), post-traumatic stress (p<.001), suicidal ideation (p<.05), delinquency (p<.001) and conduct problems (p<.001) than other-orphans and non-orphans. Anxiety showed no differences. Compared to Western norms, AIDS-orphaned children showed higher levels of internalising problems and delinquency, but lower levels of conduct problems. These differences remained when controlling for socio-demographic factors. A number of factors strongly mediated the relationship between AIDS-orphanhood and mental health. These include poverty-related factors (food, education and social security, p<.001). caregiving-related factors (caregiver illness, p<.001, excessive housework p<.001, being a streetchild, p<.001) and AIDS-related stigma (p<.001). Cumulative effects were also found. Food insecurity and AIDS-related stigma interacted to raise likelihood of disorder from 19% to 83%, and orphanhood status and bullying interacted to raise likelihood from 12% to 76%. Conclusions: This thesis shows clear evidence of heightened psychological problems amongst AIDS-orphaned children. It also indicates mediating factors and points to areas of possible intervention. The South African Ministry of Social Development plans to scale up the study to a national survey of AIDS-orphanhood.

Health Studies / (D. Litt. et Phil. (Health Studies))